关键词: 溶栓; 重组组织型纤溶酶原激活剂; 超声检查; 多谱勒; 经颅; 血液动力学现象

Abstract: Objective To investigate cerebral hemodynamic change and outcomes of acute stroke patients receiving intravenous(IV) recombinant tissue plasminogen activator (rt-PA) in an ultra early stage by transcranial Doppler(TCD) .Methods Patients receiving standard IV rt-PA therapy (0.9-mg/kg dose, maximum 90 mg, 10% bolus, 90% continuous infusion) within the first 3 hours after the onset of acute stroke and fulfilling the criteria of the National Institute of Neurological Disorders and Stroke protocol, were performedby TCD before IV thrombolysis and subsequently at 24 hours, 3days, 2 weeks and 1month after the therapy.Results Totally 18 patients received IV rt-PA and TCD monitoring. The mean age of those patients was 64.6±8.84 years old and 15 of them were male. The mean score of the National Institutes of Health(NIH) Stroke Scale score was 11.4±2.8 [ranging from 6 to 16]. Before thrombolysis, TCDmonitoring showed that 1 patient was in Thrombolysis in Brain Ischemia(TIBI) flow grade 0, 3 in TIBI grade I, 8 patients in TIBI II, 3 patients in TIBI III, 2 patients in TIBI grade IV (serious middle cerebral artery stenosis) and 1 patient in TIBI V(lacuna infarction). The average time from the onsetto IV rtPA was 2.80±0.20h, ranging from 2 to 3 hours. Recanalization occurred in 2 patients during IV-tPA infusion , 1 patient within 1 hour after IV-tPA infusion and 4 patients within 24 hours. The artery occlusion recurred in 1 patient after 4 hours of recanalization. Others have no changes. Therewas a significant difference before and after thrombolysis(24h, 3d, 2 weeks, and 1 month) in NIH stroke scale and TIBI flow grade. Both are inverted correlativity.Conclusion TCD monitoring reveals that the change of cerebral blood flow has significant correlation with the changes of neurological function. To investigate cerebral hemodynamic change can help to study the pathogenesis and effect of treatment.

Key words: Thrombolysis; rt-PA; Ultrasonography; doppler